Assisted births Flashcards
% of assisted births
10-15% overall
1/3 P0
Factors to inc/reduce assisted birth
Inc:
Epidural- in active phase
Red:
Continuous support
Upright or lateral position
Lying down- if w epidural
Delayed psuhing 1-2h
Classification of assisted births- Outlet
Outlet- Head visible wo parting labia
Head at the perineum
Rotation <45deg
Low cavity birth
Low- Head at +2, not perineum
Non-rotational <45deg, rotation >45deg
Mid cavity birth
Mid- Head at 0 or +1
<1/5 per abdo
Non-rotational <45deg, rotation >45deg
Fetal indications for assisted births
Fetal- Suspected compromise- CTG or FBS abnormal, thick mec
Maternal indications for assis. birth
P0 wo progress after 3h w epi, 2h wo epi
P1>- No progress after 2h w epi, 1h wo epi
Maternal exhaustion
Maternal medical conditions for instrumental
Maternal indications to avoid pushing-
severe cardiac disease
Heart Failure
Epilepsy
Cerebral Vascular disease
spinal cord injury
Risks/benefits of vaccum
Subgleal haemorrhage
Cephalohaematoma
Intracranial heamorrhage
Scalp trauma
Retinal haemorrhage
More likely to fail
DO NOT use in <32 weeks
Less perineal trauma
Epis 50-60%
Failure rate of vaccum
17-36%
Risks of forceps
Higher success rate
Inc OASI (8-12%) and perineal trauma
Epis 90% risk
Maternal risks vaccum vs forceps
Epis- 50-60% Vaccum, 90% Forceps
Tears- 10%V, 20% F
OASI- 1-4% V, 8-12% F
PPH 10-40% both
Incontinence- first 6 weeks then improves
Safety criteria
Head <1/5 per abdo
At spines or lower
Fully dilated
Position of fetal head known- confirm w scan
Caput and moulding <+2
Consent
Analgesia
Lighting
Operator skills
Criterias for consent
Valid consent- capacity,
Montgomery- Explain all the risks the pt would want to know
Written vs verbal- room or theatre
Trial vs CS risks
Trial- Pelvic floor morbidity (3x higher in 6 weeks)
Neonatal trauma
CS- higher maternal haemorrhage
Higher NNU admissio
